|Publication number||US20080234738 A1|
|Application number||US 11/690,148|
|Publication date||Sep 25, 2008|
|Filing date||Mar 23, 2007|
|Priority date||Mar 23, 2007|
|Also published as||CA2680657A1, EP2244646A2, EP2244646B1, US8052727, US8603146, US20120035664, WO2009016522A2, WO2009016522A3|
|Publication number||11690148, 690148, US 2008/0234738 A1, US 2008/234738 A1, US 20080234738 A1, US 20080234738A1, US 2008234738 A1, US 2008234738A1, US-A1-20080234738, US-A1-2008234738, US2008/0234738A1, US2008/234738A1, US20080234738 A1, US20080234738A1, US2008234738 A1, US2008234738A1|
|Inventors||Emmanuel Zylber, Thomas Egli, Nimrod Meier, Michael Filippi|
|Original Assignee||Zimmer Gmbh|
|Export Citation||BiBTeX, EndNote, RefMan|
|Referenced by (29), Classifications (12), Legal Events (3)|
|External Links: USPTO, USPTO Assignment, Espacenet|
This invention relates to surgical methods and associated installation systems for spinal stabilization, and more particularly to such systems and methods of inserting a flexible spinal stabilization element into a patient.
The spinal column is a highly complex system of bones and connective tissues that provides support for the body and protects the delicate spinal flexible connecting member and nerves. The spinal column includes a series of vertebrae stacked one on top of the other, each vertebral body including an inner or central portion of relatively weak cancellous bone and an outer portion of relatively strong cortical bone. Situated between each vertebral body is an intervertebral disc that cushions and dampens compressive forces experienced by the spinal column. A vertebral canal containing the spinal cord and nerves is located posterior to the vertebral bodies. In spite of the complexities, the spine is a highly flexible structure, capable of a high degree of curvature and twist in nearly every direction. For example, the kinematics of the spine normally includes flexion, extension, rotation and lateral bending.
There are many types of spinal column disorders including scoliosis (abnormal lateral curvature of the spine), kyphosis (abnormal forward curvature of the spine, usually in the thoracic spine), excess lordosis (abnormal backward curvature of the spine, usually in the lumbar spine), spondylolisthesis (forward displacement of one vertebra over another, usually in a lumbar or cervical spine) and other disorders caused by abnormalities, disease, or trauma, such as ruptured or slipped discs, degenerative disc disease, fractured vertebra, and the like. Patients that suffer from such conditions usually experience extreme and debilitating pain as well as diminished range of motion and nerve function. These spinal disorders may also threaten the critical elements of the nervous system housed within the spinal column.
One of the most common methods for treating spinal disorders is to immobilize a portion of the spine to allow treatment. Traditionally, immobilization has been accomplished by rigid stabilization. For example, in a conventional spinal fusion procedure, a rigid fixation rod is installed between pedicle screws secured to adjacent vertebrae. The fixation rod cooperates with the screws to immobilize the two vertebrae relative to each other so that fusion may occur. Fusion treatments using rigid stabilization, however, do have some disadvantages. For example, because the immobilized portion of the spine has reduced mobility, additional stresses are transferred to other portions of the spine neighboring or nearby the fused vertebrae. Fusion is also an irreversible procedure.
More recently, dynamic stabilization has been used in spinal treatment procedures. Dynamic stabilization does not result in complete spinal fusion, but instead permits enhanced mobility of the spine while also providing sufficient stabilization to effect treatment. One example of a dynamic stabilization system is the DynesysŪ system available from Zimmer Spine, Inc. of Edina, Minn. Such dynamic stabilization systems typically include a flexible spacer positioned between pedicle screws installed in adjacent vertebrae of the spine. Once the spacer is positioned between the pedicle screws, a flexible cord is threaded through a channel in the spacer. The flexible cord is also secured to the pedicle screws by a retainer and set screw, thereby retaining the spacer between the pedicle screws while cooperating with the spacer to permit mobility of the spine.
The dynamic stabilization systems described above and others are naturally installed in a patient during a surgical procedure. Patient recovery from such surgical procedures is greatly enhanced if the tissue, muscle and other parts of the patient that are displaced and affected by the surgery are minimized, including the size and severity of the required incisions. For example, the cord can be inserted through a “puncture hole” or “access channel” used to implant one of the pedicle screws and then advanced to its installed position between the pedicle screws. Due to its flexible nature, however, the cord can be difficult to maneuver through the tissue. Additional tools are often required to accomplish this positioning. As a result, the access channels for the pedicle screws must be made large enough to accommodate the tools and any manipulation required. Increasing the size of the access channels increases the disruption of muscle tissue, which should be minimized to reduce scarring and promote faster recovery times. Therefore, systems and methods that further reduce the amount of disruption to the muscle tissue are highly desirable.
This invention provides a system and method of inserting a flexible spinal stabilization element into a patient. The flexible spinal stabilization system generally includes an elongated flexible element, such as a cord, configured to be secured to first and second anchor members, such as pedicle screws, within the patient's body. The system also includes a spacer configured to be received over the flexible element. Those skilled in the art will appreciate, however, that other systems having similar components may be inserted into a patient according to the invention as well.
To insert the system, the flexible element is positioned within a sheath. The sheath may be formed from any suitable material for insertion into a patient's body. Advantageously, the sheath may be formed from a material having greater rigidity than the flexible element. The sheath and the flexible element are inserted into the patient's body at a first location on the patient's skin and along a path generally toward one of the anchor members. For example, the sheath and the flexible element may be inserted through the patient's skin at a location generally above the first anchor member and directed through the patient's body along a path extending toward the second anchor member. The shape of the sheath may help define the path, which may include a combination and straight and curved portions. The invention may also include a rigid advancement member mounted on the leading end of the flexible element for easier insertion, protection of the implant components, and other benefits described herein.
Once inserted or during the insertion, the sheath is retracted to expose a first portion of the flexible element within the patient's body. The first portion of the flexible element is then positioned in a desired position relative to the second anchor member. For example, the anchor member may be a pedicle screw having a retainer or head portion with a slot configured to receive the flexible element. In such an embodiment, the first portion of the flexible element may be positioned until it is properly located in the corresponding portion of the anchor member. A set screw or the like may be used to secure the first portion to the anchor member.
The system and method of inserting the stabilization system further comprises advancing a spacer over the sheath and the flexible element. After retracting the sheath to expose a second portion of the flexible element within the patient's body, the second portion of the flexible element is positioned relative to the first anchor member so that the spacer is positioned between the first and second anchor members. The second portion of the flexible element may be secured to the first anchor member similar to the way the first portion is secured to the second anchor member or in a different manner. Additionally, the flexible element may be cut proximate the second portion to define a separate segment.
The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate exemplary embodiments of the invention and, together with a general description of the invention given above, and the detailed description given below, serve to explain the principles of the invention.
Prior to inserting the stabilization system, the first and second anchor members 20, 22 are inserted into the patient's body 12. The first and second anchor members 20, 22 may be inserted using any technique known in the art. In one embodiment, a first incision 40 is made at a first location on the patient's skin 42 generally aligned above the first vertebra 24. The first anchor member 20 is inserted through the first incision 40 and advanced through the patient's body 12 so that it may be secured to the first vertebra 24. If desired, an access channel or puncture hole 44 may be established from the first incision 40 to the first vertebra 24 before inserting the first anchor member 20. The access channel 44 may be created by a needle or dilator (not shown) and optionally maintained by a cannula, retractor, or the like (not shown). Alternatively, the first anchor member 20 is driven through the body 12 after making the incision 40 to thereafter establish the access channel 44.
The second anchor member 22 may be inserted into the body 12 in a manner similar as the first anchor member 20. Specifically, a second incision 50 may be made at a second location on the patient's skin 42 generally aligned above the second vertebra 26. A second access channel 52 is established at the second incision 50, and the second anchor member 22 is advanced into the patient's body 12 so that it may be secured to the second vertebra 26. A wide variety of anchor members may be used with the stabilization system 10. The first and second anchor members 20, 22 shown in the drawings each include a pedicle screw 54 having a retainer member or housing 60 coupled to a top portion of the screw 54. As shown in
Prior to insertion, the cord 30 is positioned within a protective sheath 70. The sheath 70 may be made from any type of material suitable for insertion into a patient's body. In one embodiment, the sheath 70 is constructed from flexible polyethylene tubing having a rigidity greater than that of the cord 30. The strength of the sheath 70 and its ability to withstand compression forces enables it to be advanced through the tissue in the patient's body 12 without being significantly deflected. In other embodiments, the sheath can be constructed of materials such as metal to provide greater rigidity. Additionally, the cord 30 can be constructed from a flexible shape memory material such as nitinol. In its preferred configuration, the shape memory cord 30 can have a straight configuration. After loading the cord 30 into the sheath 70 or surrounding it with the sheath 70, the shape memory cord 30 can take on or conform to the configuration of the sheath 70. For example, the shape memory cord 30 can go from straight to curved. After receiving the sheath 70, the shape memory cord 30 can return to its preferred straight configuration within the housing 6o of an anchor member 20, 22.
Additionally, an advancement member 84 may be mounted on a leading end 34 of the cord 30 and in advance of the sheath 70. The advancement member 84 may be metal or any other type of material suitable for insertion into the patient's body 12. The advancement member 84 may include a leading tip 85 to facilitate movement of the cord 30 and/or sheath 70 through tissue, a main body portion 88, and a receiver section 86 adapted to accept the leading end 34 of the cord 30 and/or the leading end of the protective sheath 70. Furthermore, the advancement member 84 may have any configuration, including a bent or curved profile, to assist the surgeon when inserting the advancement member 84, cord 30, and sheath 70 into the patient. The advancement member 84 offers the advantages of easier insertion of the cord 30 into the patient, may provide fluoroscopy marking, and protects the cord 30 or other implant during manipulation by the surgeon with clamps or other instruments. The tip 85 can have any configuration such as a needle, bullet nose, or tapered shape to facilitate movement through tissue.
Therefore, as shown in
At some point after or during the insertion, the advancement member 84 is removed through the incision 50 and the sheath 70 is retracted to expose a first portion 80 of the cord 30 within the patient's body 12. Alternatively, the cord 30 can be affixed to the advancement member 84 and the cord 30 is pulled up through the incision 50. The excess portion of the cord 30 can then be cut off the flexible construct.
The first portion 80 of the cord 80 is proximate the end 34. As shown in
Still referring to
As a result of the above-described insertion procedure, the need to create incisions or access channels large enough to accommodate tools for maneuvering the cord 30 through tissue is reduced or eliminated. The advancement member 84 and/or protective sheath 70 are able to guide the cord through tissue along a desired path. To this end, the invention takes advantage of the incisions already made to insert the first and second anchor members 20, 22, thereby reducing or minimizing any additional disruption of tissue required to complete the surgical procedure. If desired, however, the cord 30 may be inserted through an incision or access channel different than those used to implant the first and second anchor members 20, 22. Use of the advancement member 84 and/or protective sheath 70 also allow for aseptic handling of the cord 30 prior to its final placement within the patient's body 12. Such handling helps reduce the risk of deep wound infections.
While the invention has been illustrated by the description of one or more embodiments thereof, and while the embodiments have been described in considerable detail, they are not intended to restrict or in any way limit the scope of the appended claims to such detail. Additional advantages and modifications will readily appear to those skilled in the art. For example, the invention described above may be used to position the cord 30 between more than two anchor members or more than two vertebrae. To this end, the cord 30 may be positioned between first, second, and third anchor members secured to respective first, second, and third vertebrae. Additionally, the sheath 70 and cord 30 may be inserted into the patient's body 12 with the first portion 80 already partially or fully exposed. Moreover, the sheath is shown and described in one embodiment as being a tubular member, but the sheath may be of another configuration that may or may not entirely surround the cord, a helical element or some other structure extending over a length of the cord and providing added rigidity to the cord during installation. The sheath may include multiple component parts assembled together from the same or variety of different materials.
The invention in its broader aspects is therefore not limited to the specific details, representative apparatus and methods and illustrative examples shown and described. Accordingly, departures may be made from such details without departing from the scope or spirit of the inventor's general inventive concept.
|Citing Patent||Filing date||Publication date||Applicant||Title|
|US7744629||May 29, 2008||Jun 29, 2010||Zimmer Spine, Inc.||Spinal stabilization system with flexible guides|
|US8016828||Jan 4, 2010||Sep 13, 2011||Zimmer Spine, Inc.||Methods and apparatuses for stabilizing the spine through an access device|
|US8137355||Dec 12, 2008||Mar 20, 2012||Zimmer Spine, Inc.||Spinal stabilization installation instrumentation and methods|
|US8137356||Dec 29, 2008||Mar 20, 2012||Zimmer Spine, Inc.||Flexible guide for insertion of a vertebral stabilization system|
|US8328849||Dec 1, 2009||Dec 11, 2012||Zimmer Gmbh||Cord for vertebral stabilization system|
|US8382803||Aug 30, 2010||Feb 26, 2013||Zimmer Gmbh||Vertebral stabilization transition connector|
|US8403963||Jan 21, 2011||Mar 26, 2013||Javier Garcia-Bengochea||Method and apparatus for spinal fixation using minimally invasive surgical techniques|
|US8465493||Mar 13, 2012||Jun 18, 2013||Zimmer Spine, Inc.||Spinal stabilization installation instrumentation and methods|
|US8603146||Oct 13, 2011||Dec 10, 2013||Zimmer Gmbh||System and method for insertion of flexible spinal stabilization element|
|US8657856||Aug 30, 2010||Feb 25, 2014||Pioneer Surgical Technology, Inc.||Size transition spinal rod|
|US8740945||Apr 7, 2010||Jun 3, 2014||Zimmer Spine, Inc.||Dynamic stabilization system using polyaxial screws|
|US8821550||Apr 29, 2013||Sep 2, 2014||Zimmer Spine, Inc.||Spinal stabilization installation instrumentation and methods|
|US8845649||May 13, 2009||Sep 30, 2014||Roger P. Jackson||Spinal fixation tool set and method for rod reduction and fastener insertion|
|US8852239||Feb 17, 2014||Oct 7, 2014||Roger P Jackson||Sagittal angle screw with integral shank and receiver|
|US8870928||Apr 29, 2013||Oct 28, 2014||Roger P. Jackson||Helical guide and advancement flange with radially loaded lip|
|US8894657||Nov 28, 2011||Nov 25, 2014||Roger P. Jackson||Tool system for dynamic spinal implants|
|US8911478||Nov 21, 2013||Dec 16, 2014||Roger P. Jackson||Splay control closure for open bone anchor|
|US8926670||Mar 15, 2013||Jan 6, 2015||Roger P. Jackson||Polyaxial bone screw assembly|
|US8926672||Nov 21, 2013||Jan 6, 2015||Roger P. Jackson||Splay control closure for open bone anchor|
|US8936623||Mar 15, 2013||Jan 20, 2015||Roger P. Jackson||Polyaxial bone screw assembly|
|US8998959||Oct 19, 2011||Apr 7, 2015||Roger P Jackson||Polyaxial bone anchors with pop-on shank, fully constrained friction fit retainer and lock and release insert|
|US8998960||May 17, 2013||Apr 7, 2015||Roger P. Jackson||Polyaxial bone screw with helically wound capture connection|
|US9050139||Mar 15, 2013||Jun 9, 2015||Roger P. Jackson||Orthopedic implant rod reduction tool set and method|
|US9055978||Oct 2, 2012||Jun 16, 2015||Roger P. Jackson||Orthopedic implant rod reduction tool set and method|
|US9055979||Dec 3, 2008||Jun 16, 2015||Zimmer Gmbh||Cord for vertebral fixation having multiple stiffness phases|
|US9144444||May 12, 2011||Sep 29, 2015||Roger P Jackson||Polyaxial bone anchor with helical capture connection, insert and dual locking assembly|
|US20140330318 *||Jul 16, 2014||Nov 6, 2014||Zimmer Spine, Inc.||Spinal stabilization installation instrumentation and methods|
|USD620109||Dec 29, 2008||Jul 20, 2010||Zimmer Spine, Inc.||Surgical installation tool|
|WO2011090806A1 *||Jan 21, 2011||Jul 28, 2011||Cannestra Andrew F||Method and apparatus for spinal fixation using minimally invasive surgical techniques|
|U.S. Classification||606/254, 606/86.00A, 606/246, 606/265|
|International Classification||A61B17/70, A61F2/44, A61F5/00|
|Cooperative Classification||A61B17/7083, A61B17/7032, A61B2017/00867, A61B17/7008|
|Mar 23, 2007||AS||Assignment|
Owner name: ZIMMER GMBH, SWITZERLAND
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:ZYLBER, EMMANUEL;EGLI, THOMAS;MEIER, NIMROD;AND OTHERS;REEL/FRAME:019053/0437
Effective date: 20070313
|Nov 18, 2008||AS||Assignment|
Owner name: ZIMMER GMBH, SWITZERLAND
Free format text: CORRECTIVE ASSIGNMENT TO CORRECT THE PROPERTY NUMBER GIVEN AS 11609148 PREVIOUSLY RECORDED ON REEL019053 FRAME 0437;ASSIGNORS:ZYLBER, EMMANUEL;EGLI, THOMAS;MEIER, NIMROD;AND OTHERS;REEL/FRAME:021847/0371;SIGNING DATES FROM 20070313 TO 20070323
Owner name: ZIMMER GMBH, SWITZERLAND
Free format text: CORRECTIVE ASSIGNMENT TO CORRECT THE PROPERTY NUMBER GIVEN AS 11609148 PREVIOUSLY RECORDED ON REEL019053 FRAME 0437. ASSIGNOR(S) HEREBY CONFIRMS THE CORRECTION OF THE RECORDATION COVER SHEET;ASSIGNORS:ZYLBER, EMMANUEL;EGLI, THOMAS;MEIER, NIMROD;AND OTHERS;SIGNING DATES FROM 20070313 TO 20070323;REEL/FRAME:021847/0371
|Apr 22, 2015||FPAY||Fee payment|
Year of fee payment: 4